Provider Demographics
NPI:1851038186
Name:WOODY, CHRISTOPHER PHILLIP
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:PHILLIP
Last Name:WOODY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEAVER CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2244
Mailing Address - Country:US
Mailing Address - Phone:678-877-9775
Mailing Address - Fax:
Practice Address - Street 1:4006 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:SHARPSBURG
Practice Address - State:GA
Practice Address - Zip Code:30277-3531
Practice Address - Country:US
Practice Address - Phone:404-960-1282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAMFT000739106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist